Can an endocrine patient participate in high performance sports?
R. Auchus1, J. Brenna2, H. Tobias2 & Y. Zhang2
The question posed by this title encompasses three issues. First, certain endocrine diseases present physiologic challenges to high-intensity or endurance activities, including type 1 diabetes mellitus and adrenal insufficiency. Using carefully adjusted insulin regimens evolved in concert with training sessions, several athletes with type 1 diabetes have succeeded in elite competitions, but the endocrinologist must train with the athlete and craft regimens that continuously deliver both insulin and glucose. Patients with adrenal insufficiency might require additional hydrocortisone for training in extreme circumstances of heat and intensity, even when fluid and electrolyte replacement appears adequate. Second, specific endocrine disorders require treatment with hormones, which are banned performance-enhancing substances. Men with hypogonadism require testosterone replacement, and type 1 diabetics require insulin therapy. For these athletes, a process called Therapeutic Use Exemption (TUE) has been developed, and this process will be reviewed. Third, certain endocrine disorders and genetic variations might confound testing for doping with androgens and lead to false-positive or false-negative test results. For example, women with 21-hydroxylase deficiency excrete higher amounts of androgens and their metabolites than unaffected women, and depending on the testing method, might be flagged for testosterone doping. A common deletion in the UGT2B17 gene impairs the capacity of some testing methods to detect testosterone doping by lowering the excretion of testosterone glucuronide but not epitestosterone glucuronide. Efforts to improve the accuracy of testing for doping with testosterone or other endogenous androgens will be discussed.
Declaration of interest: The authors declare that there is a conflict of interest.
Funding: This work was supported, however funding details are unavailable.